Paranoid schizophrenia

Paranoid schizophrenia is one of several types of schizophrenia, a chronic mental illness in

which a person loses touch with reality (psychosis). The classic features of paranoid schizophrenia
are having delusions and hearing things that aren't real.

With paranoid schizophrenia, your ability to think and function in daily life may be better than with
other types of schizophrenia. You may not have as many problems with memory, concentration or
dulled emotions. Still, paranoid schizophrenia is a serious, lifelong condition that can lead to many
complications, including suicidal behavior.

With effective treatment, you can manage the symptoms of paranoid schizophrenia and work
toward leading a happier, healthier life.

Symptoms
Signs and symptoms of paranoid schizophrenia may include:
 Auditory hallucinations, such as hearing voices
 Delusions, such as believing a co-worker wants to poison you
 Anxiety
 Anger
 Emotional distance
 Violence
 Argumentativeness
 Self-important or condescending manner
 Suicidal thoughts and behavior

With paranoid schizophrenia, you're less likely to be affected by mood problems or problems with
thinking, concentration and attention.

Key symptoms
Delusions and hallucinations are the symptoms that make paranoid schizophrenia most distinct
from other types of schizophrenia.

 Delusions. In paranoid schizophrenia, a common delusion is that you're being singled out for
harm. For instance, you may believe that the government is monitoring every move you make or
that a co-worker is poisoning your lunch. You may also have delusions of grandeur — the belief
that you can fly, that you're famous or that you have a relationship with a famous person, for
example. You hold on to these false beliefs despite evidence to the contrary. Delusions can result in
aggression or violence if you believe you must act in self-defense against those who want to harm
you.

 Auditory hallucinations. An auditory hallucination is the perception of sound — usually

voices — that no one else hears. The sounds may be a single voice or many voices. These voices
may talk either to you or to each other. The voices are usually unpleasant. They may make
ongoing criticisms of what you're thinking or doing, or make cruel comments about your real or
imagined faults. Voices may also command you to do things that can be harmful to yourself or to
others. When you have paranoid schizophrenia, these voices seem real. You may talk to or shout at
the voices.

Causes
Paranoid schizophrenia and other forms of schizophrenia are brain disorders. Genetics and
environment likely both play a role in causing schizophrenia.

Risk factors
Although the precise cause of paranoid schizophrenia isn't known, certain factors seem to increase
the risk of developing or triggering paranoid schizophrenia, including:
 Having a family history of schizophrenia
 Exposure to viruses while in the womb
 Poor nutrition while in the womb
 Stressful life circumstances
 Older paternal age
 Taking psychoactive drugs during adolescence

Signs and symptoms of schizophrenia typically develop between the teenage years and the mid-
30s.

Complications
Left untreated, paranoid schizophrenia can result in severe emotional, behavioral, health, and even
legal and financial problems that affect every area of your life. Complications that paranoid
schizophrenia may cause or be associated with include:

 Suicidal thoughts and behavior

 Self-destructive behavior
 Depression
 Abuse of alcohol, drugs or prescription medications
 Poverty
 Homelessness
 Incarceration
 Family conflicts
 Inability to work or attend school
 Health problems from antipsychotic medications
 Being a victim or perpetrator of violent crime
 Heart and lung disease related to smoking

Tests and diagnosis

 Physical exam. This may include measuring height and weight, checking vital signs, such as
heart rate, blood pressure and temperature, listening to your heart and lungs, and examining your
abdomen.
 Laboratory tests. These may include a complete blood count (CBC), screening for alcohol
and drugs, and a check of your thyroid function.

 Psychological evaluation. A doctor or mental health provider will talk to you about your
thoughts, feelings and behavior patterns. He or she will ask about your symptoms, including when
they started, how severe they are, how they affect your daily life and whether you've had similar
episodes in the past. You'll also discuss any thoughts you may have of suicide, self-harm or
harming others. Your doctor may also want to talk to family or friends, if possible.

Diagnostic criteria for paranoid schizophrenia

To be diagnosed with paranoid schizophrenia, you must meet the symptom criteria spelled out in
the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual, published by the
American Psychiatric Association, is used by mental health providers to diagnose mental conditions
and by insurance companies to reimburse for treatment.

Diagnostic criteria for paranoid schizophrenia include:

 A preoccupation with one or more delusions

 Frequent auditory hallucinations

Treatments and drugs

 Medications
 Psychotherapy
 Hospitalization
 Electroconvulsive therapy (ECT)
 Vocational skills training
Medications for paranoid schizophrenia
Medications are a key paranoid schizophrenia treatment. Among the medications most commonly
prescribed for paranoid schizophrenia are:

 First-generation (typical) antipsychotics. These medications are thought to control

symptoms by affecting brain chemicals called neurotransmitters. These medications have
traditionally been very effective in managing delusions and hallucinations. These medications,
however, have frequent and potentially severe neurological side effects, including involuntary
jerking movements. Typical antipsychotics, especially generic versions, are often cheaper than are
their newer counterparts, which can be an important consideration when you need long-term
treatment.

 Second-generation (atypical) antipsychotics. These newer antipsychotic medications are

effective at managing hallucinations, delusions and other symptoms, such as loss of motivation and
lack of emotion. Atypical antipsychotic medications pose a risk of metabolic side effects, including
weight gain, diabetes and high cholesterol.

 Other medications. It's common to have other mental health issues along with paranoid
schizophrenia. Antidepressants can be helpful if you have symptoms of depression. Anti-anxiety
medications can be helpful if you have symptoms of anxiety or agitation. And mood-stabilizing
medications may help with aggression or hostility.

Choosing a medication
In general, the goal of treatment with antipsychotic medications is to effectively control signs and
symptoms at the lowest possible dosage. Which medication is best for you depends on your own
individual situation. It can take several weeks after first starting a medication to notice an
improvement in your symptoms.

If one medication doesn't work well for you or has intolerable side effects, your doctor may
recommend combining medications, switching to a different medication or adjusting your dosage.
Don't stop taking your medication without talking to your doctor, even if you're feeling better. You
may have a relapse of psychotic symptoms if you stop taking your medication. In addition,
antipsychotic medication needs to be tapered off, rather than stopped abruptly, to avoid withdrawal
symptoms.

Medication side effects and risks

All antipsychotic medications have side effects and possible health risks. Certain antipsychotic
medications may increase the risk of diabetes, weight gain, high cholesterol and high blood
pressure, for instance. Others can cause dangerous changes in your white blood cell count or cause
health problems in older adults.

Be sure to talk to your doctor about all of the possible side effects and about being routinely
checked for health problems while you take these medications. Antipsychotic medications can also
have dangerous interactions with other substances. Tell your doctor about all medications and
over-the-counter substances you take, including vitamins, minerals and herbal supplements.

Psychotherapy for paranoid schizophrenia

Although medications are the cornerstone of paranoid schizophrenia treatment, counseling
(psychotherapy) also is essential. Psychotherapy may include:

 Individual therapy. Psychotherapy with a skilled mental health provider can help you learn
ways to cope with the distress and daily life challenges brought on by paranoid schizophrenia. One
approach, called cognitive behavioral therapy, has proven to be especially helpful in the treatment
of paranoid schizophrenia. In cognitive behavioral therapy, a mental health provider helps you
recognize — and change — harmful ideas and behaviors. As part of this process, your therapist will
help you look back on your personal history. Together you're likely to gain insights into when, and
why, you may have started to form those ideas and behaviors. Then, building from this new
understanding, your therapist can help you start to change those patterns.

Psychotherapy can help reduce the severity of your symptoms and improve communication skills,
relationships, your ability to work and your motivation to stick to your treatment plan. Learning
about paranoid schizophrenia can help you understand it better, cope with lingering symptoms and
understand how medications could be helpful. Therapy can also help you cope with stigma
surrounding paranoid schizophrenia.
 Family therapy. Both you and your family may benefit from therapy that provides support
and education to families. Your symptoms have a better chance of improving if your family
members understand your illness, can recognize stressful situations that might trigger a relapse
and can help you stick to your treatment plan. Family therapy can also help you and your family
communicate better and understand family conflicts. Family therapy can also help family members
cope and reduce their distress about your condition.

Hospitalization for paranoid schizophrenia

During crisis periods or times of severe symptoms, hospitalization may be necessary. This can help
ensure your own safety and that of others, and make sure that you're getting proper nutrition,
sleep and hygiene. Partial hospitalization and residential care also may be options.

Electroconvulsive therapy (ECT) for paranoid schizophrenia

Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through your
brain to trigger a brief seizure. This seems to cause changes in brain chemistry that can reduce
symptoms of certain mental illnesses such as paranoid schizophrenia. Because ECT can provide
significant improvements in symptoms more quickly than can medications or psychotherapy,
electroconvulsive therapy may be the best treatment option in some cases. Deciding whether
electroconvulsive therapy is a good option for you can be extremely difficult. Make sure you
understand all the pros and cons.

Social and vocational skills training for paranoid schizophrenia

Training in social and vocational skills to live independently is an important part of recovery from
paranoid schizophrenia. With the help of a therapist, you can learn such skills as good hygiene,
cooking and better communication. Many communities have programs that can help you with jobs,
housing, self-help groups and crisis situations. If you don't have a case manager to help you with
these services, ask your doctor about getting one.

Nursing Interventions
1. Build trust, and be honest and dependable, don’t threaten or make promises you can’t fulfill.
2. Be aware that brief patient contacts may be most useful initially.
3. When the patient is newly admitted, minimize his contact with the staff.
4. Don’t touch the patient without telling him first exactly what you’re going to be doing and
before obtaining his permission to touch him.
5. Approach him in a calm, unhurried manner.
6. Avoid crowding him physically or psychologically; he may strike out to protect himself.
7. Respond neutrally to his condescending remarks; don’t let him put you on the defensive, and
don’t take his remarks personally.
8. If he tells you to leave him alone, do leave- but make sure you return soon.
9. Set limits firmly but without anger, avoid a punitive attitude.
10. Be flexible, giving the patient as much control as possible.
11. Consider postponing procedures that require physical contact with hospital personnel if the
patient becomes suspicious or agitated.
12. If the patient has auditory hallucinations, explore the content of the hallucinations (what
voices are saying to him, whether he thinks he must do what they command) tell him you don’t
hear voices, but you know they’re real to him.